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What's Next For Human Engineering In Sports?

A Conversation with "The Body Builders" author Adam Piore about the future of medicine, technology, and performance-enhancement in sports.

By Patrick Hruby | VICE Sports | April 2017

A powder that helps badly damaged muscle tissue regenerate. Genetically engineered mice that can scale ladders while carrying three times their body weight. Computerized bionic limbs that function like the real thing, responding to cues in the surrounding environment. Science fiction? Guess again. In his recent book The Body Builders: Inside the Science of the Engineered Human, journalist Adam Piore explores the cutting edge of medical and scientific efforts to rebuild and augment the human body—efforts that have an intriguing amount of overlap with sports.

VICE Sports recently caught up with Piore to discuss his book, the state of current human engineering research, and potential applications for athletes. This conversation has been lightly edited for clarity.VICE Sports:When we think of using medical science to engineer human performance in sports, we generally think of performance-enhancing drugs; for example, doctors use steroids to treat muscle-wasting diseases, and then athletes quickly figure out you can use the same drugs to build more muscle in healthy people. In the book, you write about one of the next major medical frontiers—genetic therapies and modification—and how some people in sports are concerned about gene doping.In layman's terms, what is gene doping, and how is it different than the PED use we're familiar with?

Adam Piore: So gene doping is when you're basically altering your genome. You're altering the molecular blueprint in your body that tells your body how to build things. In the book, I look at a compound in your body called myostatin. It functions as an off switch for muscle growth—when your body releases it, it keeps your muscle growth within normal bounds. When you lift weights and exercise, your body turns down the amount of myostatin it releases so you get bigger.

Well, it turns out there are people with a genetic mutation who don't produce myostatin, and without that, you grow abnormally large muscles. Researchers had already found this mutation in dogs and cattle. The first confirmed case of it in humans was with a baby in Germany. The kid's mother had been a professional sprinter. His grandfather could lift entire curbstones with his bare hands. After the baby was born, doctors noticed that his muscles were quivering, and that he barely had any fat on him.That sounds like someone else you write about in your book, a little boy from Michigan named Liam Hoekstra. At five months old, he was able to grab his mother's forefingers and lift himself in the air like a gymnast doing an iron cross; at age three, he had six-pack abs, and literally punched a hole in the wall during a tantrum. Did he have the same mutation?

They couldn't find that exact mutation in him. But [scientists] think it must be something similar, a mutation that interferes with myostatin in some way.So has Liam grown into becoming some sort of super athlete? Is he still unusually strong and muscular?

They won't really know until he hits adolescence, and grows into his full adult body. He's not there yet. But he likes to play hockey and wrestling, and he's really good—so good [that] some of the parents of the kids he's playing against have complained.It's easy to see how this stuff this could apply to sports.

It's not hard! If you could change your own genome to not make this regulator anymore, it could make you stronger and more muscular. And it would be very hard to detect, for people to know if you were natural or altered.

There are other [genetic] mutations out there that mirror some of the effects people are going for when they use PEDs. There's a famous case of a Finnish cross-country skiing champion [Eero Mäntyranta, who won gold medals at the 1960 and 1964 Winter Olympics—Ed.] who had a mutation that gave him an abnormally high amount of hemoglobin in his blood. Hemoglobin is a protein that carries oxygen to your muscles, which they need for energy. If you have extra hemoglobin, you can run or work longer without tiring.

Athletes that use the drug EPO [erythropoietin] are basically doing the same thing. So again, if you could change your genome to make more hemoglobin, that would be beneficial.

Under the right circumstances, it's possible that athletes might seek medical and scientific ways to augment their physical performance. Photo by Rick Scuteri-USA TODAY Sports

So how close are we to seeing this kind of intentional genetic modification in humans? In athletes?

The human genome is enormously complex. When you're looking at using gene therapies on diseases—or gene doping—these are rare cases where a single mutation affects something, but a lot of times our diseases are caused by multiple environmental factors and genetic mutations. If you want to understand those diseases, you need to understand how hundreds of different genes that are part of a bigger genome are working together, and you also have to look at lots of people who are suffering from that disease. I went to an institute in China that has more computational and genetic sequencing power than any other place in the world, and they still don't have the firepower to map all of that out.
Still, one of the researchers I talked to in the book, Lee Sweeney, thinks there might be athletes in the Olympics who are already gene doping. He doesn't have any evidence, but he says it's already technically possible. That's something [the World Anti-Doping Agency] worries about, too.Is it possible that WADA would be able to develop tests for gene doping?

Sweeney also serves on a panel for them to come up with tests. Right now, you have to use viral vectors to deliver the genes to people. So if you test somebody in time, you can see traces of gene doping, but over time those traces will disappear, and the changes in the body will be permanent.Medical research is done under fairly stringent ethical standards—we have regulatory agencies, research review boards, even the Hippocratic oath and the simple, powerful idea of do no harm. By contrast, what we generally see in sports is that people will grab any advantage they can in order win; there's a mindset of, if one pill makes me run faster, I'm going to swallow 20. In what ways do you think it's possible that the sports world will push forward this area of human enhancement because the people in it look at risk differently, and don't necessarily care about who gets hurt in the process?

I talked to the chemist in the BALCO story, Patrick Arnold, went to visit him in his lab in Illinois. [BALCO was a mid-2000s PED scandal involving a number of prominent athletes, including Olympic sprinter Marion Jones and Major League Baseball slugger Barry Bonds —Ed.] What he had done was go to the medical literature and found a steroid that had never been approved [for medical use] before. That ended up being the basis for "the clear" [the undetectable steroid compound at the heart of the BALCO scandal]. He was working at a hair product company at the time, nobody was paying attention to him at the lab, so he just started brewing up steroids.

I reviewed his story as a cautionary tale. It's what people like Lee Sweeney are worried about, too—that the same thing will happen with gene doping. If you look at the history of steroids, a lot of what we know about their negative effects comes from studying former East German athletes who were part of a systematic, state-sponsored doping program. It may end up the same with gene therapy.

Sadly, we may learn about the unintended consequences from sports.Sweeney has personal reason to worry, right?

He does. He studies muscles, and he was always being asked to give speeches at conference for parents of children with Duchenne disease, which essentially causes your muscles to tear themselves apart over time. People always asked him, "Why isn't anyone working on this?" Also, his grandmother loved to garden, was very active, but as she became older, her muscles wasted away and she ended up bedridden.

So Lee started to study what happens in the body to cause muscle growth and repair, and the genetics of that. He ultimately gave mice a mutation that gave them huge, ripped muscles. As soon as he published his paper, he got lots and lots of media attention, and he was deluged by people in sports. I talked to his secretary, and she told me Lee was called by a high school football coach who wanted him to gene dope his whole team!

Since then, another researcher at Johns Hopkins has discovered how to create the mutation for myostatin in mice. They had ripped muscles. Chinese researchers have used gene therapy to give a dog huge muscles. Recently, Lee has made ripped golden retrievers, but he did it quietly, because every time he gets press on this, he is besieged by calls from athletes who want him to make them strong.

Weren't some of the researchers you wanted to talk to for your book so concerned about this sort of stuff that they didn't return your calls?

One researcher hung up on me when I called him. He was the author of a study about a mutation for a gene that allows you to feel pain. The backstory is that there was this kid that kept showing up in an emergency room in Pakistan. He made his money as a street performer, sticking knives in his arms. He would show up bleeding to get stitched up. The doctors thought that maybe he had a mutation to where he didn't feel pain.

So some British doctors fly out to study him. By the time they get there, the boy already had died—he had jumped off a roof, trying to impress his friends. They took genetic samples from people in his village and discovered a mutation in a gene that is involved in pain pathways in the body. If you can engineer that, you can imagine people in a boxing match or football wanting it.For me, the most no fucking way chapter in your the book involves research that is attempting to regrow human organs and limbs. Realistically, where are those efforts at right now, how do they actually work, and where might they be in the near future?

They've already found ways to regenerate large chunks of muscle. Say you lose that in your leg. Normally, your body would paste it over with scar tissue. You wouldn't grow back muscle. But now, they can mute the signaling agent that tells your body to grow scar tissue, and instead use stem cells to regrow muscle.

There are efforts to regrow bone and veins in the lab. In the next few years, we may see those therapies. In terms of organs, they've regrown a bunch of them in the lab. But with something like the lungs, it's so complicated, and if you fail, somebody could die. So some of the work is on patching organs.

Already, with a lot of donated hearts [for organ transplants], by the time they get to the transplantation pace, so much of the organ has died that you have to throw it out. So they are researching ways to repair parts of the heart tissue in order to be able to use it.

The bigger challenge is regrowing things with multiple kinds of tissue. That is much more complicated. How do the stem cells know what to become? How do they work? They get signals from their environment and that tells them what to do. We're just starting to understand what those signals are—for example, if you put more pressure on stem cells, they are more likely to grow into muscles.

There is a guy in Boston who has created worms with two heads. He does that by manipulating electrical signals. It's kind of mind blowing. He hopes in his lifetime to be able to regrow an arm. They're trying to do that with mice now. He said to me, "I fail to see how regrowing limbs is impossible. We see it in nature. Salamanders do it all the time."Could any of these sorts of therapies find their way to sports?

There's this one technique I talk about in the book—believe it or not, they found that if you put pig guts into muscle, just the scaffolding, the body tends to break it down, and that releases proteins and signaling agents that tell stem cells to converge on the site and fix things. They've tried to use this to regenerate an Achilles' tendon in a dog. They found that in humans, it was harder to do, and as the tendon grew back it was weak. But it does seem that in the future, if they can master this, they could solve some of the career-altering sports injuries we see. A lot of this is about unlocking the latent mechanisms of resilience in our bodies. That could be transformative.In another chapter, you explore efforts to create drugs that boost memory. Could that apply to sports? Wouldn't those be potentially performance-enhancing substances for chess players, or for Tom Brady—or for Bill Belichick, for that matter?

Maybe. I guess if you want to memorize a playbook or something. Speed up your learning. Those drugs have proven difficult to develop.

When they tell you that scientists are working on brain steroids. Photo by Mark J. Rebilas-USA TODAY Sports

But there's also a chapter in the book for something called implicit learning. That's even more potent. Basically, it's your unconscious pattern-matching abilities—like muscle memory, but with visual expertise. People in sports already know this: If you want to get good at hitting a baseball, you do it over and over again. It turns out the same kind of drilling applies to all sorts of unconscious expertise.

In the military, they found that soldiers kept coming back from Afghanistan and Iraq saying, "One guy in my unit always just knew when something was wrong. He could sense an ambush coming. He could feel when there was an IED. Even though he couldn't point to what, exactly, gave him that sense." That's what I'm talking about. Again, you can see this in sports, but it was a surprise in the military. They are working on ways to train this kind of intuition, and understanding how that happens in the brain.

The military is also looking at something called the accelerated learning program. This came out of studies of the brains of Marine snipers at Camp Pendleton. The researchers wanted to see if they could learn anything about brain patterns associated with a bull's-eye. They found a brain state that happens right before the bull's-eyes—it's a zone of focused attention. Then they trained other shooters, who weren't experts, while monitoring their brain states and giving them feedback, sometimes with a buzzer, when they were in that same brain state. It helped them improve twice as fast.

I'm sure you could do something similar with athletes, help train them to know when they are in the zone.One of the most intriguing characters in your book is a rock climber turned MIT researcher named Hugh Herr. Severe frostbite forced doctors to amputate both of his legs below the knee. He ends up creating his own aluminum prosthetics, and comes back to climbing better than before. That was 25 years ago. What are some of biggest breakthroughs and promising projects he has worked on since?

After the amputation, Hugh used to dream that he would wake up and run through the cornfields behind his parents' house. Now he jogs every day! He has made bionic legs that replicate all of the constituent parts of the lower leg, so it feels like you are walking on the real thing. To do that, he uses the same sort of technologies you see on EA Sports video games—the motion capture, when you see LeBron James in a suit with all those little silver balls on them. Hugh used that technology to understand how tendons, ligaments, and muscles worked in the human leg. He expresses that mathematically—if your leg hits the ground at this angle, the knee is over here, the foot is over there—and he puts that into his designs.

Recently, he developed an exoskeleton for the lower limbs. You can put it on your boot. It has motors and it feeds energy into your lower limbs as you are working, so you are able to walk and expend a lot less energy. He designed this by reverse-engineering the human leg. In 10 to 20 years from now, he says, if we want to visit a friend across town, we won't get into a large metal box. We'll just strap on the latest contraption to our legs and jog there.You also write about Herr developing a running shoe that contained two springs—one in the heel and one in the toe—connected by a strip of carbon. This was designed to catapult runners forward with extra force, and you note that the shoe could "increase speed, reduce the metabolic cost of running," and "soften the force exerted on the joints by as much as 20 percent." That sounds pretty good! You also write that Herr offered the shoe to Nike, which passed on it. What happened, and why don't we all wear running shoes like that right now?

I'm not sure. It does sound pretty cool. I don't know what [Nike] was thinking!

Justin Gatlin worked with a biomechanics expert to improve his starts and running form before the Rio Games. Photo by Kirby Lee-USA TODAY Sports

When we talk about human enhancement in sports, the story is often about medical and scientific knowledge being discovered in the larger world, usually to treat disease or injury, and then applied to running faster, jumping higher, building stronger muscles. Can it work the other way?

It can. This past summer, I went down to Orlando to watch Justin Gatlin, the 100-meter sprinter, train. He was working with a totally legal biomechanist. He and his coach claimed that he was now clean of steroids, and that the biomechanist was trying to give him more speed by using a computer program to precisely analyze the different angles of his body and stride, and maximize the efficiency of his movement.

Again, the idea was to reverse-engineer the human body, and then use that knowledge to restore and enhance performance. Justin Gatlin went from one of the slowest starting sprinters the biomechanist had ever seen to one of the fastest and best. He actually had a distinct advantage over [Jamaican sprinter and Rio Olympic 100-meter champion] Usain Bolt in that respect. Bolt's advantage was speed in the stretch. Justin was trying to overcome that by getting out of the blocks more quickly.

These same technologies are what is allowing people to build those bionic prosthetics that feel like the real thing on your leg.You write that with his very first climbing prosthetics, Herr was no longer disabled. He was augmented. What kind of mechanical augmentation might we see in the near future, and can you see or imagine any of it spreading to sports?

I tried on an exoskeleton in Japan that allowed me to lift 100 pounds with my fingertips. They have a big need for exoskeletons, because they have a large elderly population, and those people are always throwing out their backs. So they're building ones that can help people get in and out of bed. They're also building ones that help construction workers lift heavy loads.

The military is looking to augment soldier performance with exoskeletons, too, but they haven't been totally successful. You don't want to give up mobility in a firefight. But you can imagine soldiers using stuff like what Hugh Herr invented, something that saves energy during long marches.

In sports, you are going to see amputees with prosthetics who run faster than able-bodied humans. I don't think the day is very far away where we see Paralympians breaking speed records. I don't know how, exactly, they are going to manage this. It's something to think about.